Claim Denial and Rejection

Imagine you are a Revenue Cycle Consultant. For over the past 3 years, the Revenue Cycle department has been experiencing a decline in reimbursement and revenue integrity because of claim denials and rejections. You have been hired to perform a pre-bill and post-bill analysis to identify trends and opportunities for improvement. You have worked as a consultant for this facility for 6 months, and during this time you were able to come up with the final analysis:

o Incorrect or inadequate codes have been entered

o Missing information (e.g., incorrect or missing social security number)

Directions: Create a Microsoft PowerPoint presentation (no speaker notes required) for the staff. Describe the 2 issues above and provide an explanation as to how the error might have occurred for each issue. For each issue, also describe 2 recommendations on how to avoid these problems. Your PowerPoint presentation should have the minimum of 4 slides including a title and reference slide.

 

Sample Solution

also extremely difficult and close to impossible as multiple people are required to conduct a study of research. In order to reach a knowledge claim, the definition of many of these terms must be operationalized. The production of knowledge means utilizing proper research methods based on the area of study in order to reach a conclusion. Collaboration is another term that refers to working together in order to produce or create something. Working in a group effectively allows for a greater combined effect. Individual is the last term that refers to a single person working to create and establish knowledge. The knowledge claim about the production of knowledge being a collaborative task rather than an individual task has been proven to be true through various studies and articles from the natural sciences and the human sciences. Personal and shared knowledge proves the production of knowledge being a collaborative task in the natural sciences and human sciences; shared knowledge refers to the collaboration while personal knowledge refers to an individual. In abnormal psychology, collaboration can be seen through experiments explaining reliability and validity of diagnosis whereas in biology, new findings about cancer and markers involve collaboration.
The human sciences is an area of study with the aim to broaden the understanding of the human world. This involves many subjects including psychology. There are many types of psychology involved in the human sciences such as abnormal psychology, social psychology, developmental psychology, and more. Each of these also approach collaboration in a unique way. A study in abnormal psychology was completed by David Rosenhan, a professor from Stanford University, in 1973: this experiment is most commonly known as the Rosenhan Experiment or the Thud Experiment with the aim of challenging the reliability and validity of psychiatric diagnosis. There were a total of eight subjects who attempted to gain admittance into the psychiatric ward of a hospital. The participants called the hospital for diagnosis appointments and worked together to find a way to explain their condition in a way to ensure each of the 8 participants gained admittance into the hospital. They claimed they were hearing voices, an existential symptom that arises due to a meaningless life; all of the subjects were admitted as there was no mention of existential psychosis in literature. Through this, they were able to use shared knowledge as information was contributed by a group of people. After entering the ward, they stopped showing pseudo symptoms and acted as ordinary people. Even while in the psychiatric ward, the participants collaborated in order to maintain consistency between their ‘conditions.’ Each participant began to take notes about their lives in the ward. They originally took notes secretly due to their fear of the warden, but after realizing that nobody cared, they began to do this publicly, allowing public communication and collaboration. To complete the study, they continuously questioned the staff about ideas such as them being discharged to test their obdurate behavior towards the participants. The psychiatrists were not able to reliably distinguish normal people from those with an illness. A diagnostic method that makes any such errors cannot be considered valid or reliable. Collaboration was used greatly in this study as all e

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